| NPI | 1679556765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: KY 27138) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 35-060027) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2020-09-15 |